? Hyperthyroidism treatment--steroids? Ends remission?

Thanks everyone for their help on my previous post about how much to feed my cats. ( https://www.felinediabetes.com/FDMB/threads/hungry-cat-what-is-normal-ff-feeding-per-day.233165 ) We are still working out feeding times but it does seem to be helping a little bit.

I have been avoiding a hyperthyroid test because somewhere I read that the treatment for hyperthyroidism in cats is steroids and that will bring a diabetic cat in remission out of remission. I don't remember where I read this. Does anyone have experience with this?

I'm going to make an appointment for Franklin to get the test and before I arrive at the vet's office, I was wondering if anyone knew of other treatments for hyperthyroidism, if he does have it?

Thank you.

 

Hi there,

Methimazole is used to treat hyperthyroidism. To the best of my knowledge it is not a steroid.

Thyroid dysfunction can adversely impact blood glucose regulation, so treating it is more likely to have a positive effect. I've seen cats here do better when their thyroid issues are addressed.

Here's a useful article about the condition and its treatment:

Hyperthyroidism in Cats

My civvie, Lúnasa, had hyperT a few years ago (successfully treated with radioiodine therapy).

There are three methods of treatment:

* Medication (methimazole)

* Surgery

* Radioiodine Therapy

You need to first start with methimazole because hyperthyroidism can in some cases mask underlying kidney disease. If kidney issues are revealed as a result of the hyperT medication then the cat typically will stay on the meds, possibly running a little high on the thyroid side as a trade-off to help the kidneys function better. If there is no problem with kidney function. then the cat may continue on meds long term or the caregiver may opt for one of the other treatments.

HyperT is caused by excessive secretion of thyroid hormone by tumorous thyroid tissue. (The tumours are benign in well over 90% of cases.) Surgery can be used to remove tumorous tissue, but there's no guarantee it will cure the condition. Some thyroid tissue is ectopic (found in places in the body other than the thyroid gland itself) and those cells may be missed in the procedure.

The gold standard of treatment for hyperT is radioiodine therapy. The radioisotope is administered by injection. Treatment requires a stay of a couple of weeks in an authorised treatment centre, sequestering of the cat indoors for a number of weeks upon return home during which time the cat needs to remain 2 metres or so distant from all members of the household (with the exception of the few minutes it takes to deal with feeding and removing the litter box for cleaning. Precautions need to be taken when handling and disposing of urine, litter, and faeces for several weeks.

The radioisotope is highly selective in its targeting and it can destroy tumorous thyroid tissue wherever it is located in the body. In most cases, a single treatment cures the condition but occasionally a further treatment is needed. It takes a little while for thyroid levels to stabilise after the procedure. A small number of cats may end up slightly hypothyroid after treatment but this can be addressed by supplementing with thyroid hormone.

It is important to treat hyperT very quickly, otherwise the strain on the heart of the cat can lead to development of hypertrophic cardiomyopathy (thickening of the heart wall) secondary to the thyroid disorder.

Hope that helps.


Mogs
.

 

Thank you. I very much appreciate the information. I have an appointment for him on Friday to get tested. Likely won't get the results until Monday or Tuesday.

I am very grateful to have found this community a few years ago when he was first diagnosed with diabetes. You all are a tremendous and wonderful resource.

 

You and me both. FDMB helped save Saoirse's life. More than once.

((((((All at FDMB))))))




Mogs
.

 

What Dr Lisa Pierson has to say is always worth a look, I trust her judgment on most anything. She has a nice write-up on hyperthyroidism.

Note that methimazole does not cure the disease, it just controls the production of excess hormone. If feasible, the I-131 therapy is the better approach. My cat's stay in an isolation ward was just like three or four days. A number of people on the board have gone this route, and I can point you to thread where a couple of us reviewed our experiences.

Hope this helps!

 

Yes, please!


Mogs
.

 

Thank you. I will read Dr. Lisa's report.

Just got home and Franklin gives all appearances of being hungry, not only for food but my attention. He didn't want my other cat Tennessee to be closer to me than he was. I fed them each half of a can of Fancy Feast. (I've been gone for 3 1/2 hours since my meal break when I fed them a 1/2 can of FF then.)

He ate a little bit while Tennessee ate most of his. Tennessee headed off for his favorite box to curl up in. Then Franklin went over to Tennessee's bowl and made a pawing gesture..the kind they make in the litter box to bury their stuff. Then he walked back to his food and did the same pawing gesture, which he does occasionally. Then he took a couple of bites and walked away. He laid down in another room.

So is he a food bully or does he have hyperthyroidism? By the time I wake up in the morning, he will probably have finished off what is in his bowl and perhaps Tennessee's bowl as well. I fed my third one, Ellie, as well but she isn't interested so I will put that in the refrigerator.

Sometimes I will walk in from being at work for a few hours and there will be food in his bowl and as soon as I walk in, then he starts to eat it, perhaps thinking if he cleans his plate he'll get some fresh food. Which he does.

In the morning, he will start bothering me around 6:30 or so, wanting food. But since I am trying to keep somewhat of a schedule, I wait until 7:30 to feed them. His first meal he is very hungry and this is the meal where he has thrown up sometimes because he eats so fast. Since we've been using the golf ball, that has helped and he hasn't done that much. I wait about 30 minutes or an hour to let the first part of breakfast digest and then I feed him and Ellie part two of breakfast. I only use the golf ball at that first breakfast.

I've been going back and forth whether it is a behavioral thing or not but I think something else is going on. His behavior just doesn't seem normal sometimes.

I got his appointment moved up to tomorrow morning and hopefully will have the results by the weekend. They are doing a CBC and something else along with the hyperthyroid test. I checked with the pharmacy at work today and I can get methimazole there. It is $15 or $30 depending on the dosage and the pharmacist said they can probably find a discount on that.

I realize that it is not a cure but from Crittermom's post and what little else I have read, I imagine that's the first thing the vet is going to recommend. And it will probably take a few days to get the logistics worked out on radioiodine therapy. Hope to find someone who takes Care Credit. Franklin is very attached to me so hopefully he will deal well with being away for a few days. When he comes home I have read that I need to limit my time with him for the first few days. I imagine he will whine at night wanting to be near me so I may go sleep in the car!

Thanks again.

 

Here Marje/Gracie and I answer another board member's questions about what the I-131 treatment was like for us and our cats.

 

@Tom & Thomas (GA) - Thank you!


Mogs
.

 

The vet SHOULD prescribe methimazole in the first instance., and nothing else. At presentation he take a blood sample to check T4 and also kidney function (the latter as a baseline). If it is hyperT, then the status of the kidneys needs to be further assessed before any non-reversible action is taken.

It takes a few weeks on the meds then more bloodwork is run to check whether the methimazole dose is the right size and also to check whether there are any changes to kidney markers. (T4, SDMA, kidney panel, etc.).

If the kidneys are OK then all three treatment avenues open up. However, if the second round of bloodwork reveals issues with kidney function then the ongoing methimazole treatment is likely what the vet will recommend. A dose will be arrived at which offers the best balance between thyroid levels and kidney function.


Mogs
.

 

If you had the space, maybe one of these could help? (They come in various sizes - eBay or Amazon.)





The cat can be in the same room, just at a distance of about 2 metres from the rest of the household (2- and 4-legged!).


Mogs
.

 

A friend of mine has a (non-diabetic) cat that is hyperthyroid. She chose not to do surgery or radioactive iodine because there is a topical form of methimazole but synthetic thyroid hormone is only in pill form. Due to the ease of treatment, the cat is doing quite well. She just applies the cream to the skin once a day.

As a side note, I have Graves disease which translates to a hyperactive thyroid. Diagnosed in 2006, was on methimazole and beta blockers for 2 years (aiming for remission). Didn't work so I did radioactive iodine (RAI) in 2008 and I've been taking synthetic thyroid medication daily since then.

 

Tina had the I-131 treatment then got diabetes 3-4 months later. For treatment, I dropped her off on a Monday, and picked her up Friday. The people let me call anytime I wanted just to check on her. Costs vary, but ours was around 2,000. That included a pre exam: thyroid scan, and thoracic and abdominal radiographs.
Our home instructions were to keep her in her own room for two weeks, and only go in for 10 minutes of slight petting (not holding closely) twice a day. She did better with that two week routine that I did. I felt bad, but happy she never got mad at me or yowled in there all by herself!

Before the treatment, she had been on Methimazole for over a year. She was a little overtreated with the iodine, and now takes levothyroxine (like I do, since I'm hypothyroid). I have also been overdosed on levothyroxine, and went literally manic (like some hyperT cats can seem). So balance of the thyroid is critical!

Before HyperT diagnosis, Tina was much hungrier, begging for food, ate more but was losing weight. That's pretty typical I think (?)

Good luck Franklin, and scritches

 

I used the topical cream on the inside of the ear on a kitty I used to care for. Good choice, especially for a kitty that might be hard to pill. Some docs aren't sure it's as effective, but bloodwork will tell
I also know a woman who had RAI, then felt bad that she hadn't done the same for her cat.
She used Felimazole instead of Methimazole - her vet said it was better for cats.

 

Did the vet say why?


Mogs
.

 

The vet told her the Felimazole was more suited to cats - seemed to think Methimazole could be more harsh. It was the first time I'd heard of anyone using Felimazole.

 

Hmmm. At macroscopic level they're the same drug, Felimazole is just a branded version. That said, I know from direct personal experience and from empirical observations in Saoirse that, while on paper, a drug should have the same action regardless of manufacturer, there can be variations in how meds from different manufacturers may affect the body. For example, I found with Saoirse that some ondansetron generics tended to constipate her. Also, I have been prescribed anti-depressants in the past. I had been taking Prozac but my doctor then prescribed me a Prozac 'clone', Prozamel, because it was cheaper. Fluoxetine hydrochloride is the active ingredient in both meds. I got on fine with Prozac but Prozamel gave me the most horrendous nightmares.

For info, our vets prescribed the branded Felimazole for Lúnasa.


Mogs
.

 

Radioactive Iodin. Worked like a charm on Simba taking it away and normalised his blood values that did go all wack.

 

I got the blood test results and it appears I am a worry wart and Franklin is a food bully. He does not have hyperthyroidism. The vet said his blood tests all look good but he did see some gingivitis in his teeth and is suggesting a dental cleaning. He said I could monitor Franklin to see if he might be eating a little bit and then coming back later to eat a little more because his mouth might be hurting. (I don't think this is the case but will keep an eye on him.) They are going to send me an estimate on the dental cleaning but with the cost and because they put him under for that, I'm not sure about doing that right now.

The vet said he could lose a little weight. I'm trying to weigh the cats regularly once a week and today's weight was 17.0 1/2. That is a pound less than he was at the first of the year. He was 16.14 1/2 two weeks ago when I started feeding them all a little more. I asked the vet what an ideal weight for him would be and he said 13 to 14 pounds. So I'm going to have to find the right balance on feeding him enough that he isn't very hungry but not too much that he gains. I imagine it would take a year or two to get him down to 14 pounds. I should probably play with him more often to get him more exercise. I'm also still working on figuring out a regular schedule for feeding him (as regular as it could be with one of my jobs in retail with irregular hours).

Anyways, thanks again for your help. I'm lucky that he doesn't have hyperthyroidism and am now more educated about it.